Current State of ERAS Implementation in Thoracic Surgery in Germany

Abstract

In recent years, ERAS treatment pathways have found their way into many surgical fields, as they reduce complications and accelerate postoperative recovery. For thoracic surgery, the first ERAS guidelines were published by the ERAS Society and the European Society of Thoracic Surgeons (ESTS) in 2019. We have now evaluated how ERAS-items are implemented in clinical practice by using an online survey. An online survey was conducted from 12/5/2021 until 1/6/2021. The survey consisted of 22 questions focusing on the key elements of an ERAS program according to the published ERAS guidelines. Results were summarised, descriptively analysed and put into context with the current literature. Of 155 thoracic surgeons, 32 responded to the survey. In 28.1% (n=9) of the hospitals, an ERAS core unit was established, and a database to record the ERAS items existed in 15.6% (n=5). Only 3.1% (n=1) kept an ERAS-diary preoperatively. A so-called Carboloading was conducted at 15.6% (n=5) of surgeons. Standard PONV prophylaxis was administered to 59.4% (n=19) of the patients. In most cases (84.4%, n=29), a single drain was inserted into the pleural cavity during anatomic resections. In 3% (n=1) of the centres two drains, in 12.5% (n=4) no drainage was placed. The most commonly applied initial suction was -10 cmH2O (75%, n=24). Suction ≤2cmH2O was used by only two of those interviewed. Drainage removal took place in 50% (n=16) of cases between the 1st or 2nd POD, in 34.4% of cases (n=11) between the 3rd and 4th POD and in 9.4% (n=3) the drain remained longer than the 4th POD. The first postoperative mobilisation took place in 71.9% (n=23) of the centres on the day of the operation. The implementation of ERAS guidelines varies in Germany between centres. Certain perioperative processes are covered sufficiently, but the implementation of key features of ERAS is yet to be fully established in clinical practice. The first steps in this direction have already been taken and lay the foundation for cooperation across centres.